WEBVTT - Ep 217 The High Stakes of Cholesterol 0:00:00.120 --> 0:00:02.960 The first hand account for this episode features the story 0:00:03.000 --> 0:00:06.000 involving the death of a family member. Some listeners might 0:00:06.040 --> 0:00:08.680 find this upsetting, so please listen with discretion. 0:00:10.560 --> 0:00:15.720 Hi. I'm Tori, and I have familial hypocholesterolemia. I think 0:00:15.840 --> 0:00:19.360 growing up, I always knew my dad was different because 0:00:19.440 --> 0:00:23.720 he walked with a limp and he spoke weirdly. He 0:00:23.720 --> 0:00:26.720 couldn't like write or do anything, but I didn't know why. 0:00:27.360 --> 0:00:29.240 And then I remember when I was ten years old, 0:00:29.560 --> 0:00:33.319 my mom requesting that I get my cholesterol checked at 0:00:33.320 --> 0:00:37.080 a doctor's appointment, and they're like, she's ten. I think 0:00:37.560 --> 0:00:40.760 it was when they sat me down and told me 0:00:40.920 --> 0:00:43.440 that my dad had had a heart attack which turned 0:00:43.479 --> 0:00:46.000 into a stroke when I was a baby, and so 0:00:46.120 --> 0:00:49.279 that's why things were a little different. And then that 0:00:49.440 --> 0:00:52.360 the same thing happened to his father. His father was 0:00:52.400 --> 0:00:56.320 forty five. My dad was forty seven when he had 0:00:56.560 --> 0:00:59.600 his heart attack, and then they told me what causes 0:00:59.600 --> 0:01:03.200 it and why they're worried that I could have it. 0:01:03.800 --> 0:01:07.760 When I was fourteen, my cholesterol was two hundred and 0:01:07.760 --> 0:01:12.600 thirty two, which not good, and they told me, like, oh, 0:01:12.760 --> 0:01:15.040 died an exercise. Come back in a year and it 0:01:15.080 --> 0:01:17.959 was two hundred and thirty one, and so we were like, 0:01:18.120 --> 0:01:24.600 this is something more, it's not just lifestyle. But then 0:01:24.640 --> 0:01:28.240 the pandemic happened and there was like so much going on. 0:01:28.640 --> 0:01:32.240 But I finally got like tested again, and they were like, 0:01:32.319 --> 0:01:36.000 we can't put you on statin unless you have a 0:01:36.040 --> 0:01:39.320 geneticist prove that this is something. So I had to 0:01:39.360 --> 0:01:41.399 go to a geneticist, and I have a fun little 0:01:41.480 --> 0:01:45.600 chart that's like she's missing something. That's now what I 0:01:45.680 --> 0:01:48.440 live with. I'm on statin for the past two years. 0:01:48.560 --> 0:01:52.000 My cholesterol is one ninety seven, still a little high. 0:01:52.520 --> 0:01:59.000 But last July, I was taking a nap and I 0:01:59.080 --> 0:02:02.320 got like shook away by my brother in law and 0:02:02.560 --> 0:02:05.080 I hear like sobbing in the background, and I remember 0:02:05.200 --> 0:02:07.200 being told we have to go to the hospital right now. 0:02:07.920 --> 0:02:11.000 And I check my phone and there's a text from 0:02:11.040 --> 0:02:15.800 my mom that says your sister's heart stopped and the 0:02:15.880 --> 0:02:18.520 name of the hospital that they were at. And so 0:02:19.440 --> 0:02:24.040 we speed over there, and when we get there, the 0:02:24.120 --> 0:02:26.240 chaplain tells us that there was nothing they could do. 0:02:26.960 --> 0:02:30.200 She was only three weeks away from her twenty sixth birthday. 0:02:31.240 --> 0:02:34.160 It was kind of a huge shock and kind of 0:02:34.160 --> 0:02:34.520 be like. 0:02:35.680 --> 0:02:40.040 Oh, this is real, This is like real real. 0:02:40.080 --> 0:02:45.280 You know. So, yeah, that's something that I live with 0:02:46.080 --> 0:02:50.480 and the constant back in my mind. I don't really 0:02:50.520 --> 0:02:52.920 know how to talk about it unless it's like fun 0:02:52.960 --> 0:02:56.799 fact my DNA's miss you know. But it always comes 0:02:56.880 --> 0:02:58.760 up where I'm like, oh, I don't eat red meat. 0:02:59.000 --> 0:03:00.359 Oh I can't have that. 0:03:00.800 --> 0:03:03.239 I can't do this. I have to take my pills. 0:03:03.240 --> 0:03:06.160 I have a plethora of pills that I take every 0:03:06.200 --> 0:03:10.160 morning a night. For a bit, my twin had to 0:03:10.200 --> 0:03:13.359 wear a heart monitor because they now have a FIB. 0:03:14.000 --> 0:03:18.320 I've dazzled it for them. It is something that's discussed openly. 0:03:19.120 --> 0:03:21.960 I think that fear has gotten really largely into my 0:03:22.040 --> 0:03:24.560 mom's head and she's like, you have to take this, 0:03:24.560 --> 0:03:27.080 this and this, and are you doing like your exercises 0:03:27.919 --> 0:03:31.880 and stuff like that, and so I think it is 0:03:32.040 --> 0:03:36.760 just very established that this is a fear. It's a 0:03:36.800 --> 0:03:38.560 huge part of my life, and then it's a huge 0:03:38.560 --> 0:03:42.360 part of my anxiety where it's like this could be it. 0:03:42.640 --> 0:03:44.160 But I think just realizing that. 0:03:44.160 --> 0:03:46.920 This is going to be the rest of my life 0:03:47.560 --> 0:03:50.840 and it may not be as long as you know, 0:03:51.880 --> 0:03:56.120 others and my dad was lucky to survive his heart attack. 0:03:56.800 --> 0:03:58.480 His father and my sister were not. 0:03:59.600 --> 0:04:02.760 So it's just kind of this like constant worry that 0:04:03.320 --> 0:04:51.560 this might happen, and a lot sooner than you think. 0:04:52.440 --> 0:04:55.159 Torri, thank you so much for taking the time to 0:04:55.400 --> 0:04:58.839 chat with us and share your story. We deeply, deeply 0:04:58.880 --> 0:05:04.240 appreciate it. Thank you so much. Hi, I'm Aaron Welsh 0:05:04.240 --> 0:05:07.279 and I'm Erin Alman Updike, And this is this podcast 0:05:07.320 --> 0:05:08.360 Will Kill You And. 0:05:08.279 --> 0:05:14.880 Today we're talking about cholesterol today and next week. 0:05:13.800 --> 0:05:15.240 Because it's kind of a big deal. 0:05:15.400 --> 0:05:16.800 So it's going to take a while. 0:05:16.640 --> 0:05:18.400 A pretty big deal. It's a pretty big deal. 0:05:18.880 --> 0:05:19.120 Yeah. 0:05:19.160 --> 0:05:22.680 We decided to divide this up into two different episodes 0:05:22.720 --> 0:05:26.040 because the first is really about cholesterol, because you know, 0:05:26.320 --> 0:05:29.520 LDL is one just one part of the cholesterol story. 0:05:30.360 --> 0:05:33.640 Athos Gloves is just one part of the story. And 0:05:33.720 --> 0:05:35.360 so that's the story that we're going to be talking 0:05:35.360 --> 0:05:37.760 about this week, So the role of cholesterol in our 0:05:37.760 --> 0:05:41.360 bodies overall and the role of cholesterol in disease. Yeah, 0:05:41.720 --> 0:05:45.479 and then next week we're talking statins, we're. 0:05:45.279 --> 0:05:47.000 Talking what do we do about it? 0:05:47.120 --> 0:05:48.000 What do we do about it? 0:05:48.000 --> 0:05:49.920 It won't it won't just be statins, but it will 0:05:49.960 --> 0:05:53.840 be focused on like how do we lower cholesterol? And 0:05:53.920 --> 0:05:55.440 why would we lower cholesterol? 0:05:55.680 --> 0:05:58.400 Why? Yeah? How low can we go? Just kidding that 0:05:58.480 --> 0:05:59.120 is like a very. 0:05:58.960 --> 0:06:02.240 Small part, but yeah, say there is a low that 0:06:02.400 --> 0:06:03.040 is too low? 0:06:03.120 --> 0:06:03.600 Correct? 0:06:03.720 --> 0:06:06.039 Yeah? Yes, yeah, do you eat it? 0:06:06.360 --> 0:06:09.640 There's there's a lot of good material to cover, so 0:06:10.640 --> 0:06:15.080 let's just get through the rest of this intro is necessary. 0:06:15.080 --> 0:06:17.720 It's not exciting, but like you know, we want to 0:06:17.720 --> 0:06:18.440 get to the media. 0:06:18.760 --> 0:06:23.479 It's quarantine disaster. What are we drinking this week? 0:06:23.600 --> 0:06:27.359 We're drinking plac attack black attack, black attack? Are we 0:06:27.400 --> 0:06:29.560 attacking plaque? Is plaque attacking us? 0:06:29.920 --> 0:06:30.680 A little bit of both? 0:06:31.680 --> 0:06:34.719 Yeah. Plac Attack is a delicious bev. 0:06:34.880 --> 0:06:40.000 It has blueberries and lemon juice and uh sparkling water 0:06:40.279 --> 0:06:42.640 and a little bit of simple syrup and cement to 0:06:42.760 --> 0:06:44.840 make it nice and refresh. 0:06:44.600 --> 0:06:44.800 Yeah. 0:06:45.160 --> 0:06:48.320 Has nothing to do with your cholesterol, but it is delicious. 0:06:48.680 --> 0:06:48.880 Yeah. 0:06:49.240 --> 0:06:51.760 We'll post the full recipe on our website, this podcast, 0:06:51.760 --> 0:06:54.360 Akillia dot com and all of our social media channels too. 0:06:54.400 --> 0:06:56.640 So are you following us there? Because then you could 0:06:56.640 --> 0:06:57.640 see this. 0:06:57.960 --> 0:06:59.600 You could see this, You could see this. 0:07:00.920 --> 0:07:02.800 You also could see this if you go to our 0:07:02.839 --> 0:07:05.680 website This podcast will Kill You dot com, which features 0:07:05.720 --> 0:07:09.320 not just pictures of quarantine, eat recipes and still maybe 0:07:09.360 --> 0:07:13.920 videos from past one's working on that still still, but 0:07:14.000 --> 0:07:17.520 you can also find things like transcripts. You can find 0:07:17.760 --> 0:07:21.000 our show notes. You can find links to bookshop dot org, 0:07:21.160 --> 0:07:28.800 affiliate page, music by Bloodmobile, about us page, merch Patreon, 0:07:28.960 --> 0:07:31.520 submit your first hand account form, contact us form. 0:07:32.040 --> 0:07:33.480 I got there in the end, you did. 0:07:33.640 --> 0:07:35.080 You really nailed it, are and I don't think you 0:07:35.120 --> 0:07:35.960 missed a single thing. 0:07:37.320 --> 0:07:41.800 Thanks for saying that. That's all we got, right. 0:07:41.840 --> 0:07:45.400 We can just yeah, I think so, rate reviews, subscribe, 0:07:45.640 --> 0:07:49.120 do those things, and also I'll just throw it out there, 0:07:49.240 --> 0:07:51.720 you know. Thank you to everyone who has ever suggested 0:07:51.720 --> 0:07:52.960 an episode topic. 0:07:53.120 --> 0:07:54.160 It's really helpful. 0:07:54.240 --> 0:07:57.920 We love getting topic ideas from you all and feedback 0:07:57.920 --> 0:07:59.920 from you all, and so keep it up. 0:08:00.160 --> 0:08:02.240 Yeah, I love it. Also, thank you to everyone who 0:08:02.280 --> 0:08:06.200 has submitted first hand accounts too. We really do read 0:08:06.200 --> 0:08:07.880 them all, and sometimes it might take us, like I 0:08:07.880 --> 0:08:09.520 don't know, two or three years. 0:08:09.560 --> 0:08:10.360 To reach out to you. 0:08:10.960 --> 0:08:15.000 That doesn't even longer us what our record is, yeah, 0:08:15.920 --> 0:08:17.040 more than three years, But. 0:08:17.320 --> 0:08:20.080 Thank you, we really do appreciate it. And like being 0:08:20.080 --> 0:08:22.840 able to hear all of your stories and share your stories. 0:08:23.800 --> 0:08:26.960 It's what makes this podcast in our opinions, So thank you. 0:08:27.240 --> 0:08:27.880 Absolutely. 0:08:28.880 --> 0:08:31.679 Well, let's take a quick break and then get into 0:08:31.720 --> 0:08:33.160 the story of cholesterol. 0:08:33.480 --> 0:08:52.000 Let's my goal for you today is that in the 0:08:52.040 --> 0:08:55.400 next I don't know twenty minutes or so, okay, you 0:08:55.520 --> 0:08:59.920 will understand what on earth cholesterol actually is and what 0:09:00.200 --> 0:09:03.480 our bodies are supposed to be using it for, and 0:09:03.520 --> 0:09:07.679 then what your doctor actually means when they talk about 0:09:07.720 --> 0:09:11.440 your quote unquote cholesterol and why those levels matter for 0:09:11.559 --> 0:09:12.040 your health. 0:09:12.320 --> 0:09:14.160 All right, love this, Okay. 0:09:14.920 --> 0:09:19.280 So, cholesterol itself is a type of lipid molecule, and 0:09:19.360 --> 0:09:23.160 we think of lipids as fats. Technically fats are just triglycerides, 0:09:23.200 --> 0:09:26.520 but whatever think of them as fats. And it's specifically 0:09:26.520 --> 0:09:30.679 a type of lipid called a sterol, like colsterolol. 0:09:30.960 --> 0:09:31.360 Okay. 0:09:32.400 --> 0:09:35.840 Cholesterol is just a string of carbons and hydrogens and 0:09:35.880 --> 0:09:39.160 one oxygen that's formed in these little rings. There's like 0:09:39.280 --> 0:09:44.920 four rings together, so it's a pretty rigid molecule. And 0:09:45.320 --> 0:09:50.920 cholesterol is an essential molecule for all animal life and 0:09:51.040 --> 0:09:55.280 really nearly all kinds of life on Earth need things 0:09:55.720 --> 0:10:01.320 like cholesterol. So plants they don't make cholesterol, really, but 0:10:01.400 --> 0:10:03.559 they do make a whole bunch of other very similar 0:10:03.600 --> 0:10:11.880 compounds called phytosterols phytosterols phytosterols. Anyway, all except booth thank you, 0:10:12.200 --> 0:10:17.480 and fungi make their cell membranes out of something called ergosterol. Okay, 0:10:17.880 --> 0:10:22.000 sterol also, And one of the biggest things that sterols, 0:10:22.200 --> 0:10:26.520 like cholesterol for us animals does is provide shape and 0:10:26.640 --> 0:10:31.319 structure to our cell membranes. So cholesterol molecules are interspersed 0:10:31.360 --> 0:10:33.680 throughout all of our cell membranes, like the outside of 0:10:33.679 --> 0:10:36.199 our cells, which is called our plasma membrane, and then 0:10:36.280 --> 0:10:40.400 also all of our organelles inside of our cells also 0:10:40.480 --> 0:10:44.800 have membranes that also have cholesterol within them. And what 0:10:44.880 --> 0:10:48.120 this does is provide just the right amount of rigidity 0:10:48.160 --> 0:10:49.800 and structure without being. 0:10:49.640 --> 0:10:51.720 Like too solid okay right. 0:10:52.480 --> 0:10:56.040 Cholesterol molecules are also moved back and forth across these 0:10:56.040 --> 0:10:59.800 cell membranes. They interact with proteins both inside and out 0:10:59.840 --> 0:11:02.839 side side membranes, and they serve as signaling molecules that 0:11:02.920 --> 0:11:07.720 helps our cells communicate like within the cells, like between organelles, 0:11:07.760 --> 0:11:10.079 and then also between cells themselves. 0:11:10.600 --> 0:11:10.800 Hmm. 0:11:10.960 --> 0:11:13.520 It's petra a big deal does a lot of things. 0:11:13.640 --> 0:11:16.640 It really does, because I'm not even done the backbone 0:11:16.679 --> 0:11:21.040 of cholesterol. Those ring structures of carbons and hydrogens are 0:11:21.080 --> 0:11:25.960 also the precursors to all of our steroid hormones. So 0:11:26.040 --> 0:11:30.559 that's estrogen, testosterone, cortisol, all of them, and vitamin D 0:11:31.240 --> 0:11:34.400 and our biol acids, which we learned in our gall 0:11:34.440 --> 0:11:35.160 butter episodes. 0:11:35.200 --> 0:11:36.559 Pretty freaking important. 0:11:37.559 --> 0:11:42.679 So suffice to say, we need cholesterol in order to 0:11:42.760 --> 0:11:45.280 be alive, right totally. 0:11:45.800 --> 0:11:48.440 Where do we get it from? Let me tell you. 0:11:49.080 --> 0:11:51.679 We make our own cholesterol, and most all of our 0:11:51.720 --> 0:11:54.520 cells can make cholesterol, like all of our cells are 0:11:54.559 --> 0:11:58.239 capable of it, but it's a pretty energy intensive process. 0:11:58.520 --> 0:11:59.640 So the vast. 0:11:59.400 --> 0:12:02.600 Majority of cholesterol that we actually use in our body 0:12:02.640 --> 0:12:03.760 is made in our liver. 0:12:04.679 --> 0:12:05.760 And then we also get. 0:12:05.679 --> 0:12:08.640 Cholesterol and other fats and fatty acids that we also 0:12:08.720 --> 0:12:12.480 need from our diet, so we absorb it through our 0:12:12.520 --> 0:12:16.440 intestine and then that gets transported to our liver. So 0:12:16.840 --> 0:12:20.160 while our cells can make their own cholesterol, they're generally 0:12:20.200 --> 0:12:22.679 not making quite enough of it, which is why our 0:12:22.760 --> 0:12:26.040 liver makes so much, something like more than fifty percent 0:12:26.160 --> 0:12:29.840 of the cholesterol that our cells use, which means that 0:12:30.200 --> 0:12:34.520 we have to be able to deliver cholesterol from our 0:12:34.600 --> 0:12:38.880 liver and our intestine to everywhere else in our body. Yea, 0:12:39.360 --> 0:12:44.320 and our body uses blood to transport stuff around, okay. 0:12:44.240 --> 0:12:46.920 The super high ways of the body exact. 0:12:47.960 --> 0:12:52.520 And so while cholesterol is integral to life, when it 0:12:52.640 --> 0:12:54.960 ends up causing problems, which is obviously what we're going 0:12:55.000 --> 0:12:58.200 to focus on for this episode, is when that cholesterol 0:12:58.280 --> 0:13:02.439 starts building up in high amounts in places that it shouldn't. 0:13:02.960 --> 0:13:05.720 That is where we can end up seeing cholesterol cause disease. 0:13:06.360 --> 0:13:08.680 And so to understand how that happens, we have to 0:13:08.760 --> 0:13:12.280 understand how it is that our body is moving cholesterol 0:13:12.640 --> 0:13:16.319 around from our liver to our cells, et cetera, and 0:13:16.520 --> 0:13:20.240 how our cells are cycling that cholesterol, because then we 0:13:20.240 --> 0:13:23.000 can understand how this might build up in places. 0:13:22.640 --> 0:13:23.280 That it shouldn't. 0:13:24.120 --> 0:13:27.720 Now, lipids, a key thing to understand about them, including 0:13:27.800 --> 0:13:31.280 cholesterol and all of our other fatty acids, is that 0:13:31.320 --> 0:13:35.720 they are not water soluble. Right, everyone who's tried to 0:13:35.760 --> 0:13:38.880 make salad dressing knows this, and what that means is 0:13:38.920 --> 0:13:43.679 that in order to move cholesterol around our bloodstream, it's 0:13:43.760 --> 0:13:46.760 not just going to be free floating because it won't 0:13:46.960 --> 0:13:52.080 do that well. Yes, So we actually move our cholesterol 0:13:52.160 --> 0:13:56.840 around our body in little packages called lipoproteins. 0:13:57.280 --> 0:13:57.640 Okay. 0:13:58.120 --> 0:14:00.560 Now we have a bunch of different kinds of LiPo proteins, 0:14:00.640 --> 0:14:07.320 lipofat protein, protein, and they all serve different functions. Most 0:14:07.360 --> 0:14:10.480 of our cholesterol is made in our liver, right, So 0:14:10.559 --> 0:14:14.600 our liver takes the cholesterol that it makes along with 0:14:14.720 --> 0:14:18.320 other fatty acids, and connects it to a protein and 0:14:18.480 --> 0:14:22.160 sends it out in a box that we call vl DL, 0:14:22.520 --> 0:14:27.400 or very low density lipoprotein. Right, So it sends that 0:14:27.440 --> 0:14:32.280 package out, and that is the type of cholesterol package 0:14:32.800 --> 0:14:36.760 that our cells are going to end up using. Along 0:14:36.800 --> 0:14:40.680 the way in our bloodstream. This VLDL gets broken down 0:14:40.720 --> 0:14:46.400 a bit and eventually becomes a smaller box of cholesterol 0:14:46.680 --> 0:14:52.480 and other fats that we call LDL or low density lipoproteink. 0:14:53.480 --> 0:14:57.880 So VLDL and LDL these are the lipoproteins. These are 0:14:57.960 --> 0:15:02.520 the packages of cholesterol that our cells are taking up 0:15:02.840 --> 0:15:04.800 and using for cholesterol. 0:15:05.240 --> 0:15:07.960 Okay, So these are the things that our liver is 0:15:08.200 --> 0:15:11.280 making to say, here you go. Here's you said you 0:15:11.320 --> 0:15:14.320 needed some cholesterol. To make your cell membranes or make 0:15:14.400 --> 0:15:19.040 some hormones or whatever. Here's this package starts out VLDL 0:15:19.160 --> 0:15:20.520 turns into LDL R. 0:15:20.640 --> 0:15:21.760 Cells take that up. 0:15:21.840 --> 0:15:24.280 Our cells are like, awesome, I got this. They grab 0:15:24.360 --> 0:15:28.119 onto it, They bring it inside of them, protein, cholesterol, 0:15:28.160 --> 0:15:31.880 fatty acids, and all in a little package right now. 0:15:32.120 --> 0:15:35.760 Once it's in our cells, our cells can either use 0:15:35.800 --> 0:15:38.840 it or they can store it for later if they're 0:15:38.840 --> 0:15:41.920 like I want to have a little extra, or they 0:15:42.000 --> 0:15:44.720 might get way too much of it, and then they 0:15:44.760 --> 0:15:47.920 have to send it back out into our bloodstream. When 0:15:48.040 --> 0:15:51.560 our cells are going to export extra cholesterol, they do 0:15:51.640 --> 0:15:56.840 it in a package called HDL or high density lipoprotein. Okay, 0:15:56.960 --> 0:16:00.200 And that is the cholesterol that's being transported from our 0:16:00.240 --> 0:16:03.280 cells back to our liver so that our liver can 0:16:03.320 --> 0:16:07.400 recycle it or excrete it into bile acids or whatever 0:16:07.440 --> 0:16:08.440 our liver's going to do with it. 0:16:09.240 --> 0:16:09.840 That makes sense. 0:16:09.840 --> 0:16:14.200 So this is LDL being the you know, quote unquote bad. 0:16:14.080 --> 0:16:17.000 Cholesterol unquote bad because this is what's going from our 0:16:17.000 --> 0:16:20.600 liver out to our cells floating around in our bloodstream. 0:16:20.760 --> 0:16:25.640 And it's small and it is sticky, so it can 0:16:25.680 --> 0:16:29.320 get stuck in places in our bloodstream, but it's also 0:16:29.320 --> 0:16:31.320 what our cells need to take it up and use it. 0:16:31.760 --> 0:16:35.040 And then HDL is what's going from ourselves back to 0:16:35.120 --> 0:16:36.560 our liver to be recycled. 0:16:38.160 --> 0:16:42.680 Okay, what's the relationship between maybe this is jumping ahead, 0:16:42.920 --> 0:16:46.800 give it, like the relationship between VLDL and LDL. What 0:16:46.920 --> 0:16:51.080 decides how much your liver is making? If high LDL 0:16:51.200 --> 0:16:55.440 is the problem, how does that? What's that feedback cycle? 0:16:55.560 --> 0:16:55.640 Like? 0:16:56.040 --> 0:16:59.040 Oh, this is really really good question, Aaron. The balance 0:16:59.200 --> 0:17:04.320 between how much of the different types of cholesterol packages 0:17:04.560 --> 0:17:07.879 that we have VLDL, LDL, HDL, whatever it is, It 0:17:07.960 --> 0:17:11.760 depends on a lot of different things. It depends on 0:17:11.800 --> 0:17:13.560 how much your liver is making, and some of that 0:17:13.640 --> 0:17:16.359 is just genetic. Some of that might have to do 0:17:16.520 --> 0:17:20.800 with your dietary factors. We know that like diets that 0:17:20.840 --> 0:17:25.600 are high in fat, especially saturated fat, increase the total 0:17:25.640 --> 0:17:28.280 amount of all these types of cholesterol in your bloodstream, 0:17:28.400 --> 0:17:31.920 all these different cholesterol packages. We don't know why, though. 0:17:33.040 --> 0:17:35.760 It also is going to depend on how good your 0:17:35.840 --> 0:17:39.320 cells are at taking this cholesterol out of your bloodstream. 0:17:40.440 --> 0:17:44.560 And one of the main things that determines that is 0:17:44.720 --> 0:17:48.640 how many what are called LDL receptors you have on 0:17:48.720 --> 0:17:54.359 your cells. These are like velcro myths that grab on 0:17:54.680 --> 0:18:00.200 to those LDL packages of cholesterol really efficiently and pull 0:18:00.240 --> 0:18:03.000 them into the cells so that those cells can use them. 0:18:03.400 --> 0:18:06.960 But if you don't have as many LDL receptors, or 0:18:07.000 --> 0:18:10.560 your LDL receptors are not as functional as someone else is, 0:18:11.040 --> 0:18:13.480 or they just get saturated because you end up with 0:18:13.640 --> 0:18:17.080 so much of that LDL cholesterol package floating around that 0:18:17.520 --> 0:18:20.600 all your receptors are full, then you're gonna have more 0:18:20.640 --> 0:18:24.680 of that LDL cholesterol in your body. And what determines 0:18:24.720 --> 0:18:27.520 how much HDL cholesterol you have is even more unknown 0:18:27.720 --> 0:18:29.919 because there's definitely like a big genetic factor there, but 0:18:29.960 --> 0:18:32.080 we don't know, like why is it that some people's 0:18:32.160 --> 0:18:38.119 cells are exporting more HDL and others aren't. 0:18:36.760 --> 0:18:39.359 And the VLDL LDL is just sort of like that's 0:18:39.480 --> 0:18:40.840 just a natural progression. 0:18:41.160 --> 0:18:42.000 It's a progression. 0:18:42.119 --> 0:18:45.359 Yeah, And again it is going to vary person to person, 0:18:46.520 --> 0:18:51.320 like how quickly that VLDL breaks down into LDL within 0:18:51.400 --> 0:18:54.560 your bloodstream while it's like bumping around. But it's all 0:18:54.680 --> 0:18:59.080 very like person dependent. There's not like a lot of. 0:18:58.440 --> 0:19:01.760 Hsiic is so it's so tricky because yeah, there are 0:19:01.800 --> 0:19:04.840 so many different drivers of LDL. 0:19:05.840 --> 0:19:07.760 Like why why? 0:19:07.960 --> 0:19:09.840 Okay, this is getting in a little bit to the 0:19:09.840 --> 0:19:14.080 evolution question of this, but like why would it be 0:19:14.359 --> 0:19:19.679 more beneficial to have more LDL receptors or fewer receptors? 0:19:19.760 --> 0:19:22.439 Why would it be better to store cholesterol rather than 0:19:22.640 --> 0:19:23.320 utilize it? 0:19:23.720 --> 0:19:26.920 Such great questions. I don't have answers. 0:19:30.160 --> 0:19:31.800 I had a feeling you were going to say, yeah, 0:19:31.840 --> 0:19:34.440 you know, I never do, but no, those are those 0:19:34.440 --> 0:19:38.399 are all really good questions because that is really the 0:19:38.400 --> 0:19:40.879 the determinant of whether cholesterol is going to become a 0:19:40.920 --> 0:19:44.800 problem is if it is building up in the wrong 0:19:44.840 --> 0:19:48.600 places or at the wrong times. And there are actually 0:19:48.720 --> 0:19:51.720 a whole bunch of diseases that I'm not going to 0:19:51.720 --> 0:19:56.800 get into any detail on today that are where cholesterol 0:19:56.920 --> 0:19:59.600 is building up not outside of ourselves, not in our 0:19:59.640 --> 0:20:02.840 bloods stream, but actually inside of our cells. 0:20:03.560 --> 0:20:04.800 So you can. 0:20:04.720 --> 0:20:09.480 Get build up of fats and cholesterol after that cholesterol 0:20:09.480 --> 0:20:11.600 has been taken up into our cells if you can't 0:20:11.720 --> 0:20:15.560 export it right. So for example, there's a genetic disorder 0:20:15.600 --> 0:20:19.199 called Niemen Pick disease. Okay, and this is where you 0:20:19.280 --> 0:20:23.720 have a defective basically exporter molecule, and so you would 0:20:23.720 --> 0:20:27.760 have really low HDL levels, low HDL levels and just 0:20:27.840 --> 0:20:31.080 low cholesterol levels overall because you're still taking up cholesterol 0:20:31.680 --> 0:20:33.760 from your bloodstream, but then you can't get rid of it, 0:20:33.800 --> 0:20:37.520 and now your cells are too full of cholesterol, right, 0:20:37.600 --> 0:20:38.960 so that's going to be really detrimental. 0:20:39.240 --> 0:20:40.040 There are other. 0:20:39.880 --> 0:20:42.040 Ones as well, and I'm not going to get into 0:20:42.080 --> 0:20:45.000 deep detail, because the way that we tend to worry 0:20:45.040 --> 0:20:50.280 about the build up of cholesterol for most people is 0:20:50.359 --> 0:20:53.359 when it builds up in our bloodstream, because that is 0:20:53.400 --> 0:20:56.560 when we see increased risk of a number of different diseases, 0:20:56.640 --> 0:21:02.240 but especially atherosclerosis, which is the fancy name for when 0:21:02.400 --> 0:21:05.040 cholesterol builds up in your blood vessels. 0:21:08.000 --> 0:21:15.159 Okay, so cholesterol meaning these packages, these LDL packages specifically. 0:21:14.520 --> 0:21:18.800 Well, yes, so here's what happens when you have high 0:21:18.880 --> 0:21:24.560 levels of these LDL packages, or not just LDL packages 0:21:24.640 --> 0:21:28.680 but other like VLDL, like other cholesterol packages that are 0:21:28.720 --> 0:21:33.879 not HDL. Okay, okay, non HDL cholesterol. If that's high 0:21:33.960 --> 0:21:40.320 levels in your bloodstream, then sometimes because many of those particles, 0:21:40.400 --> 0:21:46.280 especially LDL packages, are small and sticky in our blood vessels, 0:21:46.640 --> 0:21:50.240 especially maybe at say bifurcations, like somewhere where your blood 0:21:50.280 --> 0:21:53.200 vessels split or a curvature, or a place where you 0:21:53.320 --> 0:21:57.520 got damage for some reason or another. Those molecules can 0:21:57.560 --> 0:22:01.639 get stuck along the walls of our blood vessels and 0:22:01.680 --> 0:22:05.760 they get just underneath the first layer of cells into 0:22:05.840 --> 0:22:10.280 the wall of our blood vessel, and once they are there, 0:22:10.960 --> 0:22:14.720 those packages kind of disintegrate, and then you do have 0:22:14.920 --> 0:22:19.800 just free cholesterol molecules in the wall of our blood vessel, 0:22:20.280 --> 0:22:23.439 and our immune system is like, whoa dude, You're not 0:22:23.440 --> 0:22:26.080 supposed to be here. You're only supposed to be inside 0:22:26.119 --> 0:22:29.679 of cells or attached to your little protein package. What 0:22:29.680 --> 0:22:32.159 the heck are you doing here? So our immune system 0:22:32.160 --> 0:22:37.760 triggers a huge inflammatory response, and then that cycle basically 0:22:37.800 --> 0:22:41.720 can kind of continue. More cholesterol gets stuck because there's 0:22:41.760 --> 0:22:46.440 inflammation in the wall of your blood vessel. That triggers 0:22:46.760 --> 0:22:50.440 more inflammatory markers to come in, and then over time 0:22:50.480 --> 0:22:53.919 you get this build up of actual free cholesterol, not 0:22:54.040 --> 0:22:57.960 just these packages, but like cholesterol floating underneath the wall 0:22:58.000 --> 0:23:01.400 of your blood vessel. Okay, and then as these plaques 0:23:01.440 --> 0:23:03.959 build up and our body is trying to respond to it, 0:23:04.040 --> 0:23:07.600 eventually we build this kind of fibrous cap over it, 0:23:08.000 --> 0:23:12.240 our smooth muscle cells build a cap and eventually they calcify, 0:23:12.800 --> 0:23:16.280 and that's all our bodies response to try and stop 0:23:16.359 --> 0:23:19.720 this thing that's in the walls of our blood vessels 0:23:19.800 --> 0:23:21.840 from taking over essentially. 0:23:22.960 --> 0:23:28.800 Okay, so it's essentially a numbers game in that, you know, 0:23:28.880 --> 0:23:32.360 we can throw things like the LDAL receptors in there, 0:23:32.440 --> 0:23:35.440 we can throw, but ultimately it comes down to how 0:23:35.560 --> 0:23:38.760 much LDL is in your bloodstream that is not being 0:23:38.800 --> 0:23:43.040 taken up by cells for whatever reason, and that just 0:23:43.359 --> 0:23:48.880 is associated with more of these little clogs, these sort 0:23:48.880 --> 0:23:51.240 of sticking to the walls of your arteries, and then 0:23:51.720 --> 0:23:57.240 that cholesterol leaking out into the actual lining, causing inflammation 0:23:57.600 --> 0:24:01.120 and an immune response, which then leads to hard and plaques, 0:24:01.160 --> 0:24:04.280 et cetera, and problems down the line. 0:24:04.200 --> 0:24:07.920